ObjectiveTo introduce the etiology and prevention of bone cement implantation syndrome (BCIS). Methods The literature about BCIS at home and abroad in recent years was extensively reviewed, and the incidence, clinical manifestations, etiology, and prevention of BCIS were summarized and analyzed. Results The clinical manifestations of BCIS are diverse. The etiology of BCIS is not completely clarified, and it may be related to circulating methyl methacrylate-mediated model, embolus-mediated model, histamine release and hypersensitivity response, complement activation and multimodal model. BCIS prevention begins with the identification of high-risk patients in preoperative evaluation and communication between surgeon and anesthesiologist about the choice of implant type, surgical procedure, and technique to minimize the risk of cardiovascular complications in high-risk patients with multiple or severe risk factors or comorbidities. Preoperative assessment and optimization of a patient’s cardiovascular reserve is also critical to prevent BCIS. ConclusionBCIS is a possible complication after hip joint arthroplasty, and its pathogenesis needs to be further research in order to provide new ideas for prevention and treatment.
目的 探討經皮椎體成形術（percutaneous vertebroplasty，PVP）后新發椎體骨折的發生率及危險因素。 方法 回顧分析2004年1月-2009年1月行經PVP治療的80例骨質疏松伴椎體壓縮骨折的患者的臨床資料，隨訪7～54個月，了解患者的療效和預后。 結果 術后80例中14例（17.5%）30個椎體新發椎體骨折，其中相鄰椎體占46.7%（14/30）。有無新發椎體骨折兩組間及相鄰和非相鄰椎體骨折兩組間，體重指數（body mass index，BMI）比較差異均統計學意義（Plt;0.05），而年齡、性別、骨折椎體個數、PVP手術椎體個數、骨水泥注射劑量、身高下降比較差異無統計學意義（Pgt;0.05）。經logistic回歸分析發現低體重指數（BMI≤18.5 kg/m2）是PVP術后新發椎體骨折的獨立危險因素。術后患者均給予抗骨質疏松藥物治療，58.8%（47/80）的患者能堅持抗骨質疏松藥物治療1年以上。采用KaplanMeier法計算術后第1年新發椎體壓縮骨折的發生率為8.6%。低新發椎體骨折發生率與患者術后堅持抗骨質疏松治療相關。 結論 低體重指數是PVP術后新發椎體骨折的獨立危險因素，與PVP手術本身無關。術后堅持抗骨質疏松藥物治療能夠降低新發椎體骨折的發生。
ObjectiveTo review the role of dendritic cells (DC) in immune metabolism of rheumatoid arthritis (RA). MethodsLiterature on the role of DC in the immune metabolism of RA was extensively reviewed in recent years, and the metabolic characteristics of RA, the role of DC in RA, the correlation between the immune metabolism of DC and pathogenesis of RA, and the treatment were summarized and analyzed. Results DC promotes the progression of RA under hypoxia, increased glycolysis, inhibition of oxidative phosphorylation, and decreased lipid metabolism. Moreover, many DCs (especially conventional DC and monocyte-derived DC) have different functions and phenotypic characteristics in RA, which are closely related to the occurrence and development of RA. Conclusion DC plays an important role in the immune metabolism of RA, and immunometabolism therapy based on DC can provide targeted therapy for the treatment of RA.
ObjectiveTo evaluate the value of blood urea nitrogen to creatinine ratio (UCR) in predicting the condition and prognosis of severe pneumonia patients.MethodsA total of 408 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 1, 2017 to August 1, 2020 were retrospectively collected. The patients were divided into a survival group (320 cases) and a death group (88 cases) according to the outcome of hospitalization. This study analyzed the relationship between UCR level and general information, condition, and treatment needs of severe pneumonia patients; and compared UCR, the value of neutrophil to lymphocyte ratio, the levels of hematocrit, C-reactive protein, procalcitonin and D-dimer, and the scores of Acute Physiology and Chronic Health EvaluationⅡ and Pneumonia Severity Index between the survival group and the death group. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of the above indicators. Logistic regression was used to analyze the risk factors of death of severe pneumonia.ResultsThe age of the patients died of severe pneumonia was higher than that of the survival patients (P<0.05); The mortality rate of severe hospital acquired pneumonia was higher than that of severe community acquired pneumonia (P<0.05); The level of UCR was higher in the patients over 70 years old (P<0.05); UCR level of the severe pneumonia patients with acute exacerbation of chronic obstructive pulmonary disease or multiple organ dysfunction syndrome during hospitalization was higher (P<0.05); The UCR level was higher in the patients with severe pneumonia whose ICU stay was more than 10 days (P<0.05); The UCR level of the severe pneumonia patients with mechanical ventilation longer than 180 hours was higher (P<0.05); UCR level of the severe pneumonia patients who died during hospitalization was higher than that of the survival group (P<0.05); The area under ROC curve of UCR for predicting death in the patients with severe pneumonia was 0.648 (95%CI 0.576 - 0.719), the cut-off value was 108.74, the sensitivity was 47.7%, and the specificity was 77.8% (P<0.05). PSI > level 3 (OR=4.297, 95%CI 2.777 - 6.651) and UCR > 108.74 (OR=0.545, 95%CI 0.332 - 0.896) were independent risk factors for death in the patients with severe pneumonia (P<0.05).ConclusionUCR has certain value in evaluating the condition and prognosis of severe pneumonia patients.
Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.
ObjectiveTo establish and internally validate a predictive model for poorly differentiated adenocarcinoma based on CT imaging and tumor marker results. MethodsPatients with solid and partially solid lung nodules who underwent lung nodule surgery at the Department of Thoracic Surgery, the Affiliated Brain Hospital of Nanjing Medical University in 2023 were selected and randomly divided into a training set and a validation set at a ratio of 7:3. Patients' CT features, including average density value, maximum diameter, pleural indentation sign, and bronchial inflation sign, as well as patient tumor marker results, were collected. Based on postoperative pathological results, patients were divided into a poorly differentiated adenocarcinoma group and a non-poorly differentiated adenocarcinoma group. Univariate analysis and logistic regression analysis were performed on the training set to establish the predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the model's discriminability, the calibration curve to assess the model's consistency, and the decision curve to evaluate the clinical value of the model, which was then validated in the validation set. ResultsA total of 299 patients were included, with 103 males and 196 females, with a median age of 57.00 (51.00, 67.25) years. There were 211 patients in the training set and 88 patients in the validation set. Multivariate analysis showed that carcinoembryonic antigen (CEA) value [OR=1.476, 95%CI (1.184, 1.983), P=0.002], cytokeratin 19 fragment antigen (CYFRA21-1) value [OR=1.388, 95%CI (1.084, 1.993), P=0.035], maximum tumor diameter [OR=6.233, 95%CI (1.069, 15.415), P=0.017], and average density [OR=1.083, 95%CI (1.020, 1.194), P=0.040] were independent risk factors for solid and partially solid lung nodules as poorly differentiated adenocarcinoma. Based on this, a predictive model was constructed with an area under the ROC curve of 0.896 [95%CI (0.810, 0.982)], a maximum Youden index corresponding cut-off value of 0.103, sensitivity of 0.750, and specificity of 0.936. Using the Bootstrap method for 1000 samplings, the calibration curve predicted probability was consistent with actual risk. Decision curve analysis indicated positive benefits across all prediction probabilities, demonstrating good clinical value. ConclusionFor patients with solid and partially solid lung nodules, preoperative use of CT to measure tumor average density value and maximum diameter, combined with tumor markers CEA and CYFRA21-1 values, can effectively predict whether it is poorly differentiated adenocarcinoma, allowing for early intervention.
ObjectiveTo systematically evaluate the risk factors for postoperative delirium (POD) in patients undergoing lung resection. MethodsPubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and VIP databases were searched from the inception to November 7, 2024 for cross-sectional studies, case-control studies, and cohort studies on POD in patients undergoing lung resection. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature. RevMan 5.4.1 software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the literature. ResultsA total of 12 studies were included, with 5 574 patients. The quality scores of the literature were all ≥6 points. Meta-analysis results showed that age (≥60 years) [OR=2.43, 95%CI (2.01, 2.93), P<0.01], ASA classification (Ⅳ) [OR=8.74, 95%CI (5.23, 14.61), P<0.01], history of diabetes [OR=12.81, 95%CI (10.45, 15.71), P<0.01], history of cerebrovascular disease [OR=3.00, 95%CI (2.46, 3.67), P<0.01], depression [OR=7.27, 95%CI (5.46, 9.67), P<0.01], squamous cell carcinoma [OR=4.79, 95%CI (1.83, 12.51), P<0.01], malnutrition [OR=5.25, 95%CI (3.35, 8.25), P<0.01], sleep disorders [OR=2.79, 95%CI (2.28, 3.42), P<0.01], and duration of one-lung ventilation during surgery [OR=1.32, 95%CI (1.11, 1.57), P<0.01] are all risk factors for POD, while high body mass index [OR=0.96, 95%CI (0.95, 0.97), P<0.01] is a protective factor for POD. ConclusionAge (≥60 years), ASA classification (Ⅳ), history of diabetes, history of cerebrovascular disease, depression, squamous cell carcinoma, malnutrition, sleep disorders, and duration of one-lung ventilation during surgery are independent risk factors for POD, while high BMI is a protective factor.
【摘要】 目的 評價亞洲骨質疏松自我評價工具（OSTA）和我國婦女骨質疏松篩選工具（OSTC）與四川地區圍絕經期和絕經后漢族婦女骨密度的關系，比較兩種工具對骨質疏松癥的篩檢能力，探討其臨床應用價值。 方法 2010年7—10月篩選獲得356名45歲以上婦女的雙能X線骨密度儀腰椎、股骨頸和全髖骨密度數據，利用體重和年齡分別計算OSTA指數與OSTC指數，并進行比較。 結果 OSTA指數與OSTC指數和各部位骨密度值均呈正相關（r=0.458~0.593和r=0.440~0.599，Plt;0.001），兩種篩選指數之間呈正相關（r=0.956，Plt;0.001）。按兩級危險程度分類界值進行判定，OSTA和OSTC的靈敏度分別為78.2%、93.5%，特異度為67.2%、43.0%，受試者工作特征曲線下面積為0.792、0.798，Kappa系數為0.452、0.357。 結論 OSTA與OSTC應用于四川地區圍絕經期和絕經后婦女骨質疏松癥的篩查效果均不理想，臨床應用價值受限。【Abstract】 Objective To evaluate the relationship between osteoporosis self-assessment tool for asians (OSTA), osteoporosis self-assessment tool for Asians (OSTC) and bone mineral density in Sichuan perimenopausal and postmenopausal women of Han nationality, and discuss the value of their clinical application through comparison of the screening ability of the two tools in predicting osteoporosis and low bone mass. Methods With the data of bone mineral density at lumbar spine, femoral neck and total proximal femur measured by DXA of 356 women aged 45 years old and above, OSTA and OSTC risk indexes of each subject were calculated based on their weight and age, and were then compared. Results The bone mineral density of above-mentioned locations were positively correlated with OSTA and OSTC indexes (r=0.458-0.593 and r=0.440-0.599,Plt;0.001), and these two indexes were also correlated positively (r=0.956, Plt;0.001). According to the two risk levels by these cutoffs, OSTA and OSTC indexes could diagnose osteoporosis with the sensitivity of 78.2% and 93.5%, the specificity of 67.2% and 43%, the area under ROC curve of 0.792 and 0.798, and the Kappa value of 0.452 and 0.357, respectively. Conclusion Both OSTA and OSTC were not ideal tools for screening osteoporosis in perimenopausal and postmenopausal women in Sichuan province.
ObjectiveTo introduce implantation methods of different types of congenital heart disease occluder for the treatment of bronchopleural fistula (BPF) and its preliminary efficacy.MethodsThree patients who diagnosed with BPF and treated by congenital heart disease occluder were reviewed. The clinical data was analyzed after comprehensively reviewing of relevant literature.ResultsAll the three patients were treated with postoperative BPF and empyema. The diameter of the fistula ranged from 3 to 8 mm. We used occlusive devices for congenital heart diseases such as atrial septum (ASD), ventricular septum (VSD) defect or patent ductus arteriosus (PDA), respectively. After treatment, all three patients were cured of BPF and empyema caused by BPF in a short time, and the thoracic drainage tube was successfully removed. During the follow-up period from 7 to 25 months, no significant long-term complications were observed.ConclusionThe use of ASD, VSD and PDA occluder for the treatment of BPF with a fistula more than 3 mm is effective and safe.
ObjectiveTo investigate the efficacy of vagus nerve stimulation (VNS) in the treatment of refractory epilepsy in children and the key factors affecting its efficacy. MethodsThe clinical data of 22 children with drug-resistant epilepsy who received VNS treatment in the Second People's Hospital of Hunan Province from January 2016 to April 2023 were analyzed. The average seizure reduction rate, effective rate and McHugh grade were used to evaluate the efficacy of VNS after at least 1 year follow-up. Patients with an attack reduction rate of ≥50% were defined as respondents, and Mann-Witney U test and χ2 test were used, respectively, to conduct univariate and multifactor Logistics regression analysis with statistically significant indicators (P<0.05). ResultsAmong the 22 patients, the average attack reduction rate was 12.66% at 1 month, 26.10% at 3 months, 37.47% at 6 months, 48.18% at 9 months and 54.38% at 12 months. The effective rate was 5.00%, 9.00%, 36.00%, 50.00% and 68.00%, respectively. 12 months after operation, there were 3 cases of grade I, 12 cases of grade II, 7 cases of grade III, and 0 cases of grade V. Unifactorial and multivariate Logistic regression analysis showed that the curative effect of epilepsy in children was related to the seizure type, among which the curative effect of general seizure was better than that of focal seizure (OR=0.062, P=0.014), and the curative effect of myoclonic seizure and tonic seizure was better than that of other types in general seizure. ConclusionThe clinical effect of VNS in the treatment of refractory epilepsy in children is time cumulative, and the surgical effect of myoclonic seizures and tonic seizures in general seizures is better.